Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.124 Integrative Medicine Insights: Comprehensive Health Strategies and Beating Osteoporosis with Dr. John Neustadt

• Michele Henning Folan • Episode 124

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Our guest this week is Dr. John Neustadt, an esteemed integrative medical expert, researcher, and author. Dr. Neustadt helps us understand how integrative medicine goes beyond the conventional approach by addressing the root causes of diseases and focusing on prevention. Through his vast experience and personal journey in the field, he enlightens us on how natural products, functional medicine, and holistic practices can significantly enhance our well-being. His insights are invaluable for anyone looking to understand the true essence of health.

This episode also dives deep into osteoporosis, offering a comprehensive approach to treatment that transcends pharmaceutical intervention. Discover the critical roles of nutrition, exercise, and key nutrients like protein, collagen, and vitamin K2 in bone health. We'll provide actionable tips and evidence-based strategies to help you build stronger bones and improve overall health. From balancing exercises to understanding the importance of vitamin K2, calcium, and vitamin D, we cover it all to empower your health journey.

You can find Dr. John Neustadt, ND, and his company, NBI Health at:
https://www.nbihealth.com/

The book "Fracture-Proof Your Bones - A Comprehensive Guide to Osteoporosis" is available on the NBI website and Amazon.

Dr. Neustadt also has a podcast called "Delivering Health".


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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling rundown. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
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Michele Folan:

I believe my family and friends thought it was a little crazy for me to leave my secure corporate job to pursue fitness and nutrition coaching, and I will say that I would likely not have done this even four years ago. But this podcast has opened my eyes to the multifaceted challenges of women's midlife health that even my 26 years in the health industry didn't teach me. I am much like you. Maybe you've been through menopause and now you're trying to figure out how you're going to ensure your longevity and mobility for the next 30 plus years. My mission wasn't to look like my 24-year-old self again, but I wanted to have energy, sleep well, feel comfortable in my clothes and not be a burden to my children when I'm older. I want to control what I can control. I wanted to find a program that met me where I was and one that would undo all that diet culture had thrown at me. And guess what? You can lose weight, that belly fat and feel amazing in your 50s and beyond. Are you ready to make a commitment to your future self? Shoot me an email or reach out on social media. We can chat about your goals and see if my program will suit your needs. Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife.

Michele Folan:

I'm your host, michelle Follin, and this is Asking for a Friend. When you host a health and wellness podcast and have amazing and smart guest experts, it forces me to do some homework and do my own research. I'm a bit of a nerd and find this process very fun and often enlightening. The area of integrative medicine is a specialty that I find intriguing, as it delves into the causes of disease rather than putting a band-aid on symptoms. Prevention is the key to long-term health, and there is a large medical community out there banging the drum to get us to lay the foundation for longevity now, rather than wait for the sometimes inevitable outcomes.

Michele Folan:

Dr John Neustadt has an international reputation as a doctor, researcher and integrative medical expert. He became renowned in this field through his nutritional medicine research, clinical work, the books he's written and the work with the FDA on evaluating the use of natural products for the potential treatment of rare diseases products for the potential treatment of rare diseases. Dr Neustadt has published more than 100 medical articles, written four health and wellness books and is now a number one Amazon bestselling author in the field of osteoporosis. His most recent book is Fracture-Proof your Bones A Comprehensive Guide to Osteoporosis. Dr Neustadt was also an editor of the textbook Laboratory Evaluations for Integrative and Functional Medicine, which was used across the United States to train and educate physicians on using functional medicine with their patients. Dr John Neustadt, welcome to Asking for a Friend.

Dr. John Neustadt:

Thank you, and I'm sure there are lots of friends out there who have lots of questions, so I look forward to providing information that's helpful.

Michele Folan:

Well, and when we get to this stage in life, we often feel like the wheels are starting to fall off, and some of it is the menopause symptoms that are often weird the frozen shoulder and the you know, the aches, the pains, the brain fog.

Dr. John Neustadt:

Yep, the night sweats, libido changes, all of it. Skin changes, hair. Yes, so there's a long list.

Michele Folan:

There is, but I think, now that you know we are a little more educated on this, that we're able to seek help and seek answers with our healthcare providers. So I think things have changed quite a bit just since I started doing this podcast two years ago. I would like you first of all, to fill in the gaps a little bit, if you will, about your introduction. Where are you from?

Dr. John Neustadt:

Where you went to school. Currently I'm in San Diego. I grew up in Southern California but have lived all over the world and I think that's really informed my approach to what I do, because I've been exposed to various ways of living, both with respect to the daily rhythms of life, which is different between countries and has a very powerful effect on health and well-being different dietary patterns, different medical systems. I studied botany and in my undergraduate work I was focusing in two areas. One was a cellular and molecular biology of plants and the other was a field of study called ethnobotany. Ethnobotany is how the societies use plants and plant-derived materials for food medicine and in commerce for food medicine and in commerce. And I then went into work. I was a journalist for a while. I did marketing and technical writing for software companies. So I've always loved to research and to write and to communicate ideas, which is why I've written so much, because I believe for me that process of distilling what the information is into something that I could communicate to lay people. If I can do that, then I know that I truly understand it.

Dr. John Neustadt:

I was in the high-tech world when I started to get sick and was not doing well, went to a medical doctor who was just part of an insurance list, didn't know him, went in the door and he had his prescription pad out as soon as he walked in the exam room. He got impatient by my questions. I really wanted to understand what was going on with my body. I obviously, based on what I've told you already, was interested in more holistic and integrative approaches. I also was bike commuting to work. I was doing a lot of gardening and growing a lot of my own food. It was something that I was passionate about even before going to medical school. And he just wanted to write a prescription and move on to the next patient. Well, medicine to me is a service industry and, like any service industry, if I don't like the service, I'm going to go find somebody else who's going to give me the service that I need, especially when it comes to my own body, my own health and my own future.

Dr. John Neustadt:

I'd heard of Bastyr University, which is a naturopathic medical school in the Seattle area. Their teaching clinic was just down the street, so I thought what have I got to lose? So I decided to make an appointment. Their chief medical officer was the lead physician on my appointment. He had two student clinicians with him. They spent 45 minutes with me, answered all my questions and really helped me understand the underlying causes of what was happening, what I could do myself. And at the very end, dr Wallace that was the chief medical officer's name.

Dr. John Neustadt:

He looked at me, got to know me so well during that appointment. He said you need to quit your job. He realized during that appointment that what was happening to me was really due to chronic stress, which is deadly, and part of that chronic stress was being caused because I was in a career that I didn't love. It was not something that I was passionate about. It was increasing my stress. I was miserable and I think that at that time in my life that was that sort of third-party validation.

Dr. John Neustadt:

I was looking for somebody to recognize what I already know and I think a lot of people already know intuitively what they need. But having somebody else there to witness that, to verbalize it, can be very helpful in certain stages of life and that's what I needed. So I quit my job the next week, started enrolling in medical school. Fortunately I'd already done most of all the prerequisites of my undergraduate and it's been. I was in 2000,. Graduated in 2005. And for the last 17 years, now 19 years, my goodness, almost 20 years I've been working with patients and researching and writing and trying as best I can to help people understand, like me, what they can do, what questions they should be asking, to make sure they're getting the best possible recommendations and care.

Michele Folan:

This is so perfect because we do talk about pivots career pivots, life pivots finding that thing that lights you up, and you found that through a medical situation, so I think that's really fascinating and really cool.

Dr. John Neustadt:

Yeah, it's important. I think that people understand that life is fluid and there are opportunities always to pivot, to change, and I understand there are perhaps structural issues in people's lives. When it comes to if I, at that point, were married and had had kids and a mortgage and my calculations and what I did may have been different, but I still would have transitioned out of what I was doing because for my long-term health and it's not just my own physical health we all know that when we are around people who are passionate and excited and happy with what they're doing, that's contagious and in fact, studies have shown that that mood and energy and even diet is contagious, that if you are surrounded by people who are depressed and overeating, you are more likely to attain to get those attributes as well. To attain to get those attributes as well.

Michele Folan:

That makes a lot of sense. So I think we are what we eat and we are who we hang out with, and so I have had other integrative health practitioners on my show before, but we've never really defined the difference in integrative medicine versus traditional medicine. Can you just talk about that? You did a little bit in your telling your story, but is there a delineation between the two?

Dr. John Neustadt:

So conventionally, medicine is taught in a very reductionist approach that leads people down the path to specialization. So if you've got a problem with your liver, you go to a hepatologist. With your heart, you go to a cardiologist. With your kidney, you go to a nephrologist. And even with general practice docs they're not really taught biochemistry within their medical program and how that relates to health. They're not really taught to think of how the different systems integrate within the body and they're not taught nutritional medicine, botanical medicine, lifestyle counseling. They may refer and understand that diet is important, but research has even shown within the area of bone health and osteoporosis which is what one of my major areas of expertise is in that that disease is being mistreated and undertreated. Because one of the reasons is because doctors don't understand, they're not trained to have those more nuanced conversations with patients around diet and lifestyle. They don't really quite understand how to navigate that, and so when you look at that conventional model, then it comes down to what do they have to offer? Well, it's primarily drugs and surgery. When you look at the integrative medicine and what is becoming more integrated into the conventional system, unfortunately there still isn't really a great definition that's widely accepted of what that means. So I can be a medical doctor in my clinic and bring in a massage therapist and say we offer integrative medicine. But integrative medicine is this nebulous sort of concept. I like to define it more in terms of the philosophy, because all of these other things massage, nutritional medicine, botanical medicine those are what are called modalities, drugs and surgery. But what is the underlying philosophy motivating it? That's going to inform and impact the conversation that we're having with patients. It's going to impact what we recommend to patients. And so when you look at the conventional system, there's only one philosophical tenant. That's first do no harm. So what does that really mean in practice? It's not well-defined. My degree, my medical degree, is in naturopathic medicine. It's a naturopathic doctorate degree and within that we have clearly defined a philosophy that is first do no harm, but then also includes things like doctor. As teacher, one of our most important jobs is to teach patients how their bodies work so they can take better care of themselves.

Dr. John Neustadt:

Treat the underlying cause, not just a symptom. I'm all for drugs and surgery when necessary, but the research is clear that many times they're not. When you look at just these acid blocking medications like proton pump inhibitors, studies have shown that 30, 40 or more percent of those prescriptions aren't even necessary. So there are ways of looking at what is the underlying cause and how can we treat that, to either avoid drugs and surgery or minimize the dosage.

Dr. John Neustadt:

And then the other thing is the healing power of nature, and that for me comes down to not only biochemistry, but there's this intangible sense of purpose that people have, the sense of things that fulfill them in their life that we're touching on a little earlier.

Dr. John Neustadt:

Can we harness that to help improve people's health, as well as working with the body's own biochemical processes and biochemistry is very complicated, people get whole PhDs in it but very simply it's how the body's own biochemical processes and biochemistry is very complicated, people get whole PhDs in it but very simply it's how the body uses vitamins and minerals and fats and proteins to do its job and how things like environmental toxins and nutritional deficiencies and chronic stress and infections interfere with that and create diseases and symptoms. And can we identify what's gone wrong and correct the system correct actually what's happening in a very individualized approach so that we can actually help people heal and flourish? And then, within that kind of realm of integrative medicine, there's a concept called functional medicine. So functional medicine has gained popularity, that term has become popular and really that means looking at how the body functions, both physically from a movement point of view, but more often than that it's looking at those underlying hormonal and biochemical issues. And can we correct that? So more of a nutritional medicine type of approach.

Michele Folan:

This was a great explanation and I appreciate this so much because just to have you kind of lay that out there, I think lays the foundation for this conversation. So thank you for that very much. You have written a book. It's called Fracture Proof your Bones and I'm curious what motivated you first to write about this topic and then, how did you get interested in bone health?

Dr. John Neustadt:

I was motivated to write the book because people kept coming to me for answers to this issue, and what I'd been working with patients on for 15, 17 years by the time I wrote the book was something I wanted to get out to the wider audience. How I became interested in it was because I needed to understand this, because I was having patients coming into me with osteoporosis, and one of my mentors in college and medical school one of the founders of my university, dr Bill Mitchell, taught a fourth-year class called Advanced Therapeutics, a requirement for all students, and in it he said at one point if you listen close enough, your patients will tell you what they need. Your patients are going to be your best teachers and if you're doing your job right, if you don't know the answer, it's your job to go figure it out. I had patients coming to me and I was doing and treating their bone health and their osteoporosis as I was taught as a young doctor. That's pretty much all we've got to go on. We're just trained and we're working with patients as we were taught. But what happened was their bone density was going up. So I was happy, right, and they were happy.

Dr. John Neustadt:

My mother-in-law, who's now 93 years old almost 94, she has osteoporosis and had osteoporosis. At the time I was helping her with some nutritional recommendations and recommendations on diet and supplements and lifestyle. Her medical doctor had prescribed Fosamax to her so she was taking that as well and her bone density was going up. So she was happy, her physician was happy, I was happy. And then she fell on a throw rug in her house and broke her hip and I thought to myself something is wrong with this picture, because by all objective measures that are conventionally and even in the integrative world tracked, she should have been protected and she wasn't.

Dr. John Neustadt:

I started diving into the research and the literature and what I found shocked me. That almost exclusive focus on the number on the test is so limiting that it only predicts 44% of women with osteoporosis who will break a bone and only 21% of men. It's not the number on a test that is the most dangerous thing with osteoporosis. It's whether or not somebody breaks a bone. Osteoporosis is second globally only to cardiovascular disease as a health concern. Every 30 seconds someone with osteoporosis is breaking a bone and if you're a woman with osteoporosis and you break a hip, there's up to a 36% chance that you're going to be dead within a year If you do survive.

Dr. John Neustadt:

About half of those patients never regain their pre-fracture level of mobility and pain-free life that they had, and a significant number of them continue to need help with their activities of daily living getting dressed, going to the bathroom.

Dr. John Neustadt:

They lose that independence that they had before and, shockingly, two more things I want to say that I think will put this in context for people is that if you're a 45-year-old woman, your lifetime risk of getting an osteoporosis fracture is equal to your combined risk of breast, uterine and ovarian cancer, and osteoporosis fractures cause more days spent in the hospital than other diseases like heart attacks, diabetes and breast cancer.

Dr. John Neustadt:

So when I started to learn all this stuff, my focus totally changed. It moved away from just looking at a number of a test to asking the most important question what can I do to help people reduce their risk for fractures? What can I do to, yes, improve their bone density, their risk for fractures? What can I do to, yes, improve their bone density? But that's only one piece of a much larger puzzle. Every health organization that's looked at the data has correctly concluded that fracture risk depends on factors largely other than bone density, and so that's what I focus on in the book helping people walk through, step-by-step, what they can do to create their own bone health plan and what questions they can ask of their healthcare providers to make sure they're getting the best recommendations.

Michele Folan:

Okay, you have my mind going a hundred miles an hour, so I'm going to try to remember all the questions that I wanted to ask you about this. So my first question would be about the bisphosphonates, so Fosamax type of medications out there. I have been told and I don't want to spread misinformation that you do get some bone building with these drugs, but may not be quality bone. Can you address that?

Dr. John Neustadt:

That is correct. So let me put this in context within the sort of physiology of the bone and how bone, what makes up bone and how bone strength is really determined, so that I think it'll make my answer to not only the question about the medications but also, moving forward, what people can do, it'll make more sense. So bone is primarily made up of two metabolically active cells osteoblasts and osteoclasts. Osteoblasts build up new bone, healthy bone, and osteoclasts break old bone down, worn out bone and basically recycle it. That process is called bone remodeling and we need that healthy balance of those two cells and their activity to maintain strong bones. Now, as we're growing and into our 20s, the activity of the osteoblasts is faster than the osteoclasts. We've got more bone being built than broken down and peak bone density occurs in our 20s, typically for men and women. And what happens then? Osteoporosis is essentially a condition of imbalance. Something's out of balance in the system, where then the osteoclasts start working faster than the osteoblasts and you've got bone being broken down faster than it can be made. Now that bone remodeling, as I said, is necessary, and in fact about every 10 years in healthy bone, in a healthy system, you've got all new cells, you have total bone turnover With the medications.

Dr. John Neustadt:

The medications target different aspects of those cells. So the Fosamax and those bisphosphonate category medications they stop, they poison the osteoclast. They stop the bone breakdown so that natural healthy bone remodeling is not there. So you've got old, worn out bone that stays around that doesn't get broken down, and then you've got new bone, that bone that stays around, that doesn't get broken down, and then you've got new bone that's being formed around it and on top of it and so you get an abnormal deposition of bone and you can get weaker bones. Now there is a situation that is documented that if you're taking these medications they can actually increase your risk for fractures. It's a small percentage of patients that that happens to, but it is significant. And if you do fracture when you're taking one of these medications the bisphosphonate medications it actually takes longer for your bone to heal.

Dr. John Neustadt:

The most important question to ask when it comes to these medications is does it reduce my fracture risk? In my diagnosis and with my medical history and in the osteoporosis medications chapter I walk people through the logic of that and why it's important to ask those details. And here let me give you a very concrete example that I think everybody could easily understand. There are two main categories of fracture prevention that we work with. Clinically it's called primary prevention and secondary prevention. Primary prevention means you haven't had a broken bone before with osteoporosis. We're trying to prevent you from breaking one in the first place. Secondary prevention is you've had one fracture or two. We're trying to prevent you from having more.

Dr. John Neustadt:

So when you look at the research on the medications for primary fracture prevention in postmenopausal osteoporosis, the bisphosphonate medications do a good job of reducing vertebral fractures, fractures of the spine. However, they don't prevent hip fractures. So I don't know why you'd only want to prevent fractures at one site, especially because hip fractures are the more deadly type. But that's what the data show and most physicians are not aware of that. The other thing with the medications that I think is important to understand, specifically with the bisphosphonates, is there's only one that's been shown to prevent both primary vertebral and primary hip fractures and that's intravitus zometa. So if a medication is appropriate, if somebody chooses to do that, the better medication in terms of the fracture prevention for primary prevention is zometa. If you're looking at secondary fracture prevention, you've already broken a bone and we're trying to prevent you from breaking more. Then you have more options. The bisphosphonates are more effective, and then you have other categories of medications like donosovab, exchiva, forteo and other ones as well.

Michele Folan:

Okay, so I was diagnosed with osteoporosis last year. I have osteoporosis in my spine and I have osteopenia in my hips.

Michele Folan:

I'd be very interested. So if I came to you as a patient and, by the way, I was told to and my listeners have heard me say this before I was told to up my calcium, my vitamin D take, here's your prescription for Fosmax. We'll see you back in two years. That's what I was told and I said no. I said I'm not doing that, I'm going to go a different route with this. I'm so. That's what I did. But I'd be interested, like I said, if I were your patient and I came in with that diagnosis, what you would recommend for me.

Dr. John Neustadt:

Great question. So the first thing I do with patients is I talk to them and put that bone density test in its proper place, because people come in there, they're so anxious about it, so definitely tracking that, and we want to see that increase. But it's one piece of a much larger puzzle. So it's not so easy for me to just say to you what I would recommend, because there are a couple of questions that I would need to ask. First, again, this integrative medicine, naturopathic medicine, is individualized. It's not a one size fits all. So one of the health screens that's really important to do is somebody's medications that they're taking. There's an old chapter in my book on that. There are so many medications that destroy bone and increase fracture risk. It is ridiculous and doctors are unwittingly prescribing these medications and having no idea. Let's take the acid blocking medications, for example. I already mentioned those. The proton pump inhibitor specifically, like the Prilosec Protonix. We know or rather the FDA first released and sent out warning letters for the increased risk of osteoporosis and fractures with those medications in 2010. That is not new. Now they're over the counter. People are taking them for years and years, even though they've never been approved by the FDA for long-term use and we know that taking that for four years increases hip fracture risk by 60%, oh Jesus. And the increase of fracture risk is evident by the first year. It's not that it just suddenly jumps up a year four, it's going up the entire time. Medications for mood depression, anything that artificially increases serotonin Lexapro, prozac, those sorts of medications they're serotonin receptors on bone and when you artificially elevate serotonin, in fact the majority of serotonin, about 95%, isn't even produced in the brain. People probably know serotonin as a happy chemical. Most of it's produced in the intestines and then that circulates in platelets throughout the body and there are a lot of serotonin as a happy chemical. Most of it's produced in the intestines and then that circulates in platelets throughout the body and there are a lot of serotonin receptors all throughout the body and it does different actions. And bone is no different. There are serotonin receptors in bone and when that artificially gets elevated it increases bone breakdown. Many studies have been done on the effects of these medications on bone and research has concluded that for women taking SSRI medications for one to five years, for every 19 women taking them we would expect one to break a bone, and even at less than one year, there's already an increased risk for fractures. And then there are a lot of other medications, certain categories of anti-seizure medications, prednisone, those glucocorticoids, that category of medications, and on and on and on. So that's the first thing I want to do.

Dr. John Neustadt:

I want to say, okay, is there anything else going on here? Because can we reduce, change your medication to a safer one? Or, even better, let's look at whatever was the reason for having that prescribed, is it necessary to take? Or can we deal with that issue let's say depression more from an integrated perspective, so you can get off of that medication? Maybe you're able to get off of it. So I want to try and minimize or decrease the destruction of the bone. Otherwise, what we're doing in terms of building bone. It's like that old what is it? Greek myth of it was a Sisyphus who's pushing the boulder up the hill. Or another analogy is you're swimming upstream. You've always got this creature that's pushing you back.

Michele Folan:

Okay, super interesting.

Dr. John Neustadt:

So then from there, it's okay. We have identified possible things that are destroying bones. What can we do to build bone backup? And there are very discrete categories that I have conversations with people in and evaluate, because the research is clear With a proper diet, a Mediterranean, plant-based dietary pattern, the closer somebody adheres to that, there's a 20% reduction in osteoporosis risk. But, more importantly, it's associated with a 21% reduction in fracture risk and hip fracture risk, even more importantly, the most dangerous type of fractures. So again, anything that anybody recommends to you, it's important to ask the question has it been shown to reduce fractures? Because that's the bottom line not just improve bone density? When it comes to other things, sleep is important. If you're not getting enough sleep, you lose bone faster. Now there are no studies looking at getting enough sleep and improvement in bone density or reduction in osteoporosis fractures, but we do know that not getting enough sleep is associated with a whole host of problems, osteoporosis being one, high blood pressure and cardiovascular disease, all-cause mortality, all of that. So making sure you're getting enough sleep is important.

Dr. John Neustadt:

Exercise is important. 95% of fractures occur because somebody falls. So anything that we can do to prevent falls and fall-related injuries is going to prevent fractures. So balance it doesn't have to be lifting weights. In fact, just walking about 7,000 to 7,500 steps per day on average is associated with a 50% to 70% reduction in all-cause mortality. Gardening is great. You can go to a gym and lift weights, but you don't have to. The important thing is to do it safely. There are certain exercises with osteoporosis that should be avoided, like certain poses in yoga that put excessive pressure on different areas. I had a patient who did the pigeon pose in yoga and fractured her pelvis because she had osteoporosis and she wasn't warned about that. Most doctors conventionally they just tell you go exercise, without really putting it in a safe context.

Dr. John Neustadt:

The other thing is important is to look at supplementation. So you'd mentioned calcium and vitamin D and the question that I ask and how I evaluate the research on nutrients is I evaluate the research on nutrients is has the nutrient been shown in clinical trials to reduce fractures Ideally improve bone density as well, but reduce fractures? Calcium and vitamin D has? We're looking at a couple different ways to think about this. One is with vitamin D. I like to test vitamin D levels and make sure people are in the healthy range. I like to test vitamin D levels and make sure people are in the healthy range. Vitamin D level of 30 to 44 nanograms per milliliter is associated with the maximum reduction in hip fracture risk. So getting your vitamin D level up to that and for immune health a lot of practitioners, myself included, want an even higher 60 or 70. But for that fracture reduction in the studies we're looking at lower than that 30 to 44. And to get that, most people can get there with about 2,000 IUs of vitamin D3 a day With calcium.

Dr. John Neustadt:

The important thing to understand is you can get too much calcium. A lot of doctors are still megadosing in calcium, which to me is not good for the patient. It's not individualized medicine and it's not supported by the research. If you get up to about 2,000 to 2,500 milligrams per day that's the upper limit of intake that can increase your risk for adverse events like cardiovascular problems.

Dr. John Neustadt:

The average American woman consumes about 800 milligrams of calcium in her diet. So if you're eating just like an average person, getting 400 milligrams of calcium as a dietary supplement is sufficient for you to reach that US recommended daily amount of 1200 milligrams per day. Getting more than 1,200 milligrams per day has no increased benefit for bone, but a lot of people or doctors are still saying well, take 1,000 or 1,200 or 1,400 milligrams of calcium as a supplement, which is a horrible recommendation. It's not supported by the research, so I like to do it more like that, in a customized way. Help people improve their diet and dose the calcium. If they have to avoid dairy, if for some reason they're not getting enough calcium, then yes, dose higher than that. But for most people, about 400 milligrams of calcium is going to be just perfect is what they need.

Michele Folan:

Okay, I've got some questions before you go on yes. Protein, getting enough protein in our diet, so that is helpful in healthy bone.

Dr. John Neustadt:

It's crucial. So what we now know is protein can account for about 2% to 4% of bone mineral density. Most people aren't getting enough protein that I talked to, and as we age you have to get higher amount of protein than even what the USRDA is to maintain strong muscle and healthy bone. Bone is a highly protein-dependent tissue. The mineral component just gives bone its hardness and that's all. The bone mineral density test is the amount of minerals that are in the bone, but the protein component of the bone, specifically the collagen in bone, is what gives bone its quality and its ultimate strength.

Dr. John Neustadt:

It's flexible. Healthy collagen is flexible so that when you fall, the force of that impact can be dispersed over a larger volume of tissue and can deform a little, bends a little bit and it's not brittle. In addition to collagen, there are about 180 to 200 different proteins in bone and I like to recommend, based on the research, that people get a minimum of 0.6 grams of protein per pound of body weight per day on average and that'll give the building blocks for your body to build that collagen and the minerals bind to the collagen, they bind to those proteins and you can supplement that with a protein powder, with a collagen powder. There's clinical trials with collagen improving bone density no fracture outcomes, but that's the closest we've got. And yes, but protein is incredibly important.

Michele Folan:

Okay, you mentioned collagen. So I have been taking collagen for at least four years. There are new collagens out there now that are advertising. It's called Fortabone. Yep, tell me a little bit about Fortabone and why that would make a regular collagen different.

Dr. John Neustadt:

Well. So, first of all, it's a proprietary product and they've done clinical trials on it. It's been shown to improve bone density, no fracture outcomes on it and I don't have a problem with that. Most of the clinical trials are done out there on generic hydrolyzed collagen type one, collagen for bone type one, and that collagen type 1 collagen for bone type 1. And the dose of 10 grams per day has been shown to reduce a blood marker that's associated with the breakdown of bone collagen, called CTX, and has been shown to improve bone density.

Dr. John Neustadt:

Why someone would use one or the other? I think it's more just preference, frankly, and price. So I'm a believer and I have a supplement company. I started out of my clinic in 2007 because I couldn't find these research-supported nutrients in the doses shown in clinical trials to work that I needed for my patients, and there are a couple other nutrients that are important to discuss when it comes to bone health that we'll talk about. But I do have a collagen that I created.

Dr. John Neustadt:

But am I going to sit here and say that my collagen is better than any other of the collagens out there? No, and I think if anybody's doing that, based on, the question I would ask is do you have a clinical trial showing me that? Because when you're giving the raw materials, a collagen is giving the amino acids which you're getting from diet as well. You're supplementing your diet and when you give your body that raw materials, it's going to put it where it needs to go anyway. So I don't think that it necessarily matters, except for type one. Collagen is the primary collagen in bone and as a protein. Protein are made up of different amino acids, so it's going to have the amino acids that are more specific to bone versus other types of collagen, like a type two collagen, for example, which comes from fish or chicken sternum.

Michele Folan:

Chicken sternum oh yummy. I have one other quick question about factors that could affect our bone density. What about alcohol?

Dr. John Neustadt:

So alcohol is an interesting subject. I think that, like a lot of things, it's a dose effect, meaning a little alcohol is probably not a problem, but if you're substituting healthy calories for the alcohol and you're not then eating a healthy diet, there is a level of abuse that could be there. I don't know what the threshold is. Is it three drinks a week? Is it four? I don't know, but I think alcohol in moderation. I don't know of any research that shows a link with osteoporosis again in moderation.

Michele Folan:

Okay, all right. You mentioned that there were some other supplements that are helpful for people with osteoporosis.

Dr. John Neustadt:

Yeah, importantly, I think it's really important to talk about vitamin K2. A lot of people have now heard about vitamin K2 for bone health, but there's a lot of confusion out there among consumers and, frankly, even in the medical literature and with the dietary supplement manufacturers and their marketing. So remember what I said before what?

Michele Folan:

is the most important question to ask when anybody recommends anything.

Dr. John Neustadt:

Will it prevent fracture Correct Hasn't been shown in clinical trials to maintain strong bones, as indicated by reducing fractures. Vitamin K2 is a category of nutrients, it's not just one. There are multiple types. They're designated by letters MK7, MK4 are the two types that you'll see in dietary supplements. Mk7 has never been shown in clinical trials. First of all, to improve bone density. It only slows down how fast somebody loses bone density and in one clinical and this is at different doses they tried different doses and in one study actually showed that the women it was in postmenopausal osteoporosis. In these women they actually lost bone mineral density in the hip faster when they took the MK7. Most studies just show that it slows down how fast somebody loses bone density. More importantly, though, there are no clinical trials showing that MK7 reduces fractures. None. Mk4 is another form of vitamin K2. It's been studied for decades. It's been approved in Japan since 1996 for bone health by the Ministry of Health.

Dr. John Neustadt:

K2. It's been studied for decades. It's been approved in Japan since 1996 for bone health by the Ministry of Health in Japan. There are over 7,000 volunteers and more than 25 clinical trials, and repeatedly it shows not only does it stop and reverse bone loss, as indicated by bone mineral density and improved bone mineral density and postmenopausal osteoporosis. But it also has been shown to stop bone loss in people with osteoporosis from medications like glucocorticoids, prednisone, from luprolide therapy, which is an androgen deprivation therapy used in prostate cancer and endometriosis and other conditions. It's been shown to be helpful in maintaining bone density in people with chronic kidney disease, and this is all in the dose of 45 milligrams per day. With respect to postmenopausal osteoporosis, not only has it been shown to improve bone density, causal osteoporosis, not only has it been shown to improve bone density, but, most importantly, to maintain strong bones, as indicated by over 70% reduction in fractures in the clinical trials.

Dr. John Neustadt:

And that's individual clinical trials. And then there are multiple, what are called meta-analyses that have been done. That's where researchers will pool the data from different studies to just confirm is there a real trend here? Does it really play out when you're looking at the different studies and you combine the data? And repeatedly, time after again, the answer is yes, and so when I was looking at this issue, I talked about how I became interested in osteoporosis and bone health because of my patients and my mother-in-law.

Dr. John Neustadt:

I discovered this research on NK4 and I looked for products that had it. It didn't exist in the clinical trial doses. And that is a bit of a pet peeve of mine with the supplement industry as a whole is that you have a lot of companies that will cite research or say their product does X because of a study, but then you look at the study and it uses a higher dose of the nutrient than what was actually used in their product or in fact uses a whole different nutrient altogether. So they're using subclinical doses and I couldn't stomach that. For my patients it had to work, it had to be based on the clinical trial doses.

Dr. John Neustadt:

So the entire genesis or origin story of my company, NBI Nutritional Biochemistry Incorporated, is to provide these to my patients. So I created OsteoK and now OsteoK Minis and those have the 45 milligrams of MK4 per day plus 2,000 IUs of vitamin D3 and just different amounts of calcium because, like I said before, not everybody needs the same amount of calcium. And now I also have a calcium-free version for people who don't need the calcium. And that is not only guaranteed to stop bone loss, to stabilize bone density, improve it, but more importantly, because of the 17 years of working with these products and this nutrient, because of the research I've done. Because of the strength of the clinical trials, my company now guarantees that within six months, not only will it stabilize or improve your bone density, but, more importantly, it'll maintain strong bones, Meaning that if you break a bone, we will refund your money for all qualifying purchases between your bone density tests.

Michele Folan:

Wow, john, that's quite a guarantee. Yeah, we'll talk afterwards. We'll talk offline, because I have never heard of that particular supplement before. This is news to me. I've had osteoporosis people on the show before, but this is information we need to be able to have so that we can go back and have these conversations with our own healthcare providers. So thank you for this.

Dr. John Neustadt:

Absolutely.

Michele Folan:

Anything else in that realm.

Dr. John Neustadt:

I want to mention strontium. You may have heard of strontium. Have you heard of that?

Michele Folan:

Yes, okay, so my mom she's no longer with us, but she had osteoporosis. She had a lot of compression fractures. She swore by strontium. She took it faithfully and there were a couple times when she fell and she probably should have broken something. She never did. She fell and she probably should have broken something. She never did Good, and that was the strontium. And I said, mom, I would, I would challenge her because of course I had come from the pharmaceutical industry and I that was my job to challenge my, my, my elderly mother, things that she was reading. But she said, look, why would any drug company make this into something? Because it's cheap. They're not going to make any money off of this. So she was right all along and so I thank you for bringing that up. Lung issues she had pulmonary fibrosis.

Dr. John Neustadt:

Okay, Did she throw a blood clot?

Michele Folan:

No.

Dr. John Neustadt:

And I'll tell you. You'll understand why I'm asking in a moment. So strontium has been shown in clinical trials to reduce fractures and that's a great testimonial that you just gave. I'm not a fan of strontium and I don't recommend it for the following reasons. I recommend MK4 and my osteoK products overshine. I don't use strontium and it'll become clear in a moment why Strontium. And it'll become clear in a moment why Strontium was made into a medication in Europe. The name of the medication is proteolus. Strontium ranolate is the product, and there are six clinical trials on strontium ranolate, which was the drug in Europe, and five of those six clinical trials only showed that it reduces vertebral fracture risk, not hip fracture risk. Only one of those studies showed a significant reduction in hip fractures. So for that reason it's not so great in my opinion.

Dr. John Neustadt:

The second thing is that strontium as a mineral incorporates into bone. It's heavier than calcium. A bone density test is an x-ray. It goes through the bone and it bounces off the minerals and that reflection, what's called a refractive index, hits the machinery and does the bone density test does its mathematical magic behind the scenes and spits out the results of a T-score and Z-scores. Well, because strontium is heavier as an atom, as a mineral, than calcium. It changes that refractive index and so the bone density test results are incorrect. They're inaccurate. It gives false bone density test results. Now, despite the limitations of the bone density test, I still want it to be accurate.

Dr. John Neustadt:

A couple other points why I don't recommend it. And it's not because of the test result, necessarily Strontium citrate, which is available in the United States. That's the only type that is available in the United States. That's the only type that's available in the United States. There are no clinical trials on strontium citrate showing that it improves bone density or reduces fractures. And it may. But there's a safety concern that I have. Strontium ranolate was removed from the market in Europe because what they found out in post marketing study and this is often the case with medications most of the side effects are not discovered until it's been on the market. So post-market data showed that for every one fracture that was prevented it created a blood clot that can cause heart attacks and pulmonary embolism and blood clots and strokes and the fracture and blood clots and strokes and the fracture reduction that you've gotten the vertebral fracture reduction in the studies that it showed was about a 45% reduction in fractures in postmenopausal osteoporosis. With MK4, 45 milligrams per day, what we see is a much higher reduction in fracture. None of the safety concerns. It does not interfere with a bone density test result.

Dr. John Neustadt:

Plus, the MK4 has other health benefits. Mk4 is the preferred form of vitamin K2 in the body and it doesn't just have effects on bone. It accumulates in other tissues throughout the body, like the pancreas, the breasts, the intestines, and has other activities. It's the only form of vitamin K that's also been shown to have anti-cancer properties without being toxic. They're up to phase two clinical trials with MK4, 45 to 135 milligrams per day in people with acute myeloid leukemia, myeloid dysplastic syndrome, liver cancer and hepatitis C, and one case report was somebody with acute pro-myelocytic leukemia all showing positive benefits with the MK4 for those patients in terms of restoring healthy cellular function and because of all of those benefits, the superior the ability of MK4 to maintain strong bones to a greater extent than strontium without any of the potential risks of strontium, and the additional benefits of helping promote healthy cellular function with MK4. That's why I have in my products the MK4, the calcium and the vitamin D and I don't have strontium anywhere.

Michele Folan:

All right, it makes total sense. But I still all the ribbing we gave my mom about strontium and how adamant she was about taking it. I mean maybe it did help her prevent fracture because she refused to do any of the bisphosphonates. But she was, listen, my mother was a strong woman.

Dr. John Neustadt:

Well, look, what I can say is nothing is 100%. You mentioned that she did have compression fractures and she did have fractures. So it sounds like even with the strontium she was having fractures.

Michele Folan:

Yeah for sure, for sure, with the strontium she was having fractures. Yeah for sure. We're certain that probably she would have had a hip or broken wrist or something at some point, because she did have a couple falls. Okay, I know that we're going over on time, but I do have a couple more questions for you. Are there any drug interactions that we need to be aware of in some of those common supplements that we take every day? Is there anything that we should kind of put on our radar?

Dr. John Neustadt:

You know, not real common. I would say that there are some, definitely some things that I'd like to educate people about. That's important. So, because I was just talking about vitamin K and specifically MK4, that if somebody's on the anticoagulant medication warfarin, they absolutely cannot take the MK4 because it antidotes the warfarin. If they're on a different type of anti-clotting medication, like Love Knox, that's totally safe. That's fine because it works by different mechanisms.

Dr. John Neustadt:

If you are taking an iron dietary supplement, so making sure you take that away from your thyroid medication or any other medications and, as a general rule, just taking medications separate from dietary supplements, is important. There are some interactions that it's not exactly the question you ask but I think are really important to understand. If you're on a beta blocker, beta blockers deplete melatonin and melatonin, as you know, is involved in sleep. But what you may not know is there are also melatonin receptors on bone and it's involved in bone health. There's a clinical trial that looked at postmenopausal women with osteopenia and gave melatonin and showed that it improved their bone density. So if you're on a beta blocker and suddenly you're having a hard time sleeping, then you might want to just start taking a little bit of melatonin. That may do the trick and talk to your doctor about that.

Dr. John Neustadt:

There is an article that I have on my website. There's one article, a comprehensive list it's an updated list of medications that cause osteoporosis and fractures and there's another article on drug nutrient depletions, and I think that's important to understand, because a lot of drugs will deplete nutrients, and so making sure you're supplementing them with a good multivitamin whether it's my Supreme Multivitamin or there are many good brands out there or another is important for many people, and just making sure that you're looking at these potential interactions between the drug and your biochemistry mostly from a standpoint of depleting essential nutrients that you need to be healthy.

Michele Folan:

Okay, I have a personal question for you. What is one of your core pillars of self-care?

Dr. John Neustadt:

That is a great question. Respecting myself, healthy boundaries, listening to what I need and articulating that in constructive ways. I think that that's really and that goes in every aspect. That goes for sleep, diet, exercise and I think also to expand on that a little bit how I've matured and grown over the years, to help me maintain more balance and truly feel probably healthier than I did even in my 20s right now, and in better shape, is I've learned to ask better questions. And I keep going back to that the same question with osteoporosis If you ask the wrong questions, you're going to get the wrong answer. So part of improving in health and making sure you're getting the right information and the best information is to be asking the best questions.

Dr. John Neustadt:

So for me, for example, I used to be in a habit of when I'm feeling tired or sad, I would ask myself why am I so tired? Why am I so tired or why am I so sad? Our brains will look for the answers to any questions we ask. So as soon as I ask that question, my brain is scanning and looking to tell me why, which just reinforces that feeling. It keeps me stuck in that feeling. So now I've learned when I've recognized I'm doing that to ask different questions.

Dr. John Neustadt:

So instead of asking why am I so tired, I asked myself what can I do to have more energy? What do I need to feel more energetic? And sometimes it's I didn't sleep well enough. I need you know if I can go lay down for 20 minutes with the power. Oh my God, I forgot to eat. Maybe I just need to eat. Maybe I forgot to. You know, I drink a certain amount of water during the day. Maybe I hadn't had enough water. Maybe I just need a break from whatever task I'm doing at work to get some fresh air and stretch my legs a little bit. But it's that sort of thing. Asking more empowering questions. How can I have more energy? How can I feel better? How can I get my bones stronger? How can I reduce my fracture risk? Those are the empowering questions.

Michele Folan:

I love that. That's really great. I would love for you to tell the listeners, dr John Neustadt, where they can find you, your books and also your products.

Dr. John Neustadt:

The best place is going to be on my website, which is nbihealthcom. Nbihealthcom. Lots of articles on there my book products. There's links to social media sites. If you want to reach out to me and contact me, you can through there as well.

Michele Folan:

Perfect, dr Neustadt, thank you so much for being on Asking for a Friend.

Dr. John Neustadt:

Thank you.

Michele Folan:

I am so grateful for the ratings and reviews from our listeners. Did you know that your reviews help other people find Asking for a Friend? If you like what you hear, won't you please leave a review on Spotify or Apple? Thank you from the bottom of my heart.